From the 2019 HVPAA National Conference
Ms. Stephanie Amport (Yale New Haven Health), Dr. Matthew Bizzarro (Yale New Haven Health), Ms. Marianne Hatfield (Yale New Haven Health)
As part of Yale New Haven Children’s Hospital journey to create a state of the art NNICU, we identified the need for a new model of care to optimize patient outcomes.
Design and implement an innovative couplet care model that prevents the separation of mother and baby by early February, 2018, to provide a family-centered facility design featuring a collaborative staffing model for mother and baby, to decrease LOS for infants, and to increase percent of infants receiving any breast feeding in the NNICU.
An iterative care redesign model guided the research, design, build and collaborative implementation of NNICU couplet care (infant requiring neonatal intensive care treatment is cared for by the NNICU team in the same room as the mother who is receiving postpartum care by the obstetrics team). An interdisciplinary oversight committee and an operations work team with medical and nursing leaders and staff from the NNICU, postpartum, and labor & birth focused on making effective use of staffing and room resources to maximize couplet care utilization. The model ensured 8 rooms could be flexed to accommodate NNICU-only and NNICU couplet care patients. Elements of the Couplet SOP included guiding principles, patient admission criteria, placement guidelines, and clinical and operational protocols including communication and response teams, integrated supportive care, emergency response, decision-making responsibility, and chain of command. The team used capacity management scenarios for care model and patient criteria development. The team assessed and integrated current state census, staffing huddles, information needs, timelines and key stakeholders to develop a phased decision-making process to offer couplet care to eligible patients. Implementation tools included:
• Couplet Patient Placement Algorithm: facilitates interdisciplinary care team conversations and allows NNICU and obstetrics services to assess, plan and implement strategies that enable decision making for patient placement
• Updated huddle model: facilitates couplet care eligibility and capacity-focused discussions
• OB and NNICU Surge Plans: allows NNICU and obstetrics to make effective decisions for allocation of staff and room resources at times of high NNICU and/or obstetrics census
• Script: guides offering couplet care to the mother
• Census matrix: integrates NNICU and Women’s Services daily huddle sheets
Go-live included a stakeholder communication SBAR and an on-unit core support team to mitigate risk and address areas for improvement. Post go-live debriefing sessions led to the development of a NNICU Couplet Steering Committee and Task Force to address operations, bed utilization, ensure seamless care, and assess patient and family experience.
The NNICU couplet care model went live on Tuesday, February 18th, 2018. Data analysis compared 244 infants in couplet care to 346 control infants >=34 weeks’ gestation who were cared for in the old unit from 1/1/16-12/31/17.
Focused on providing value-based, state of the art family-centered care, the team met their objectives and significantly reduced median length of stay and increased percentage of infants that receive any breast milk. Building NNICU couplet care was a structured, time bound multidisciplinary team effort that brought together two services to develop a significantly more family-centered care model.
The opportunity to standardize care by keeping more postpartum mothers and babies requiring intensive care together could result in better short and long term outcomes for babies, lower costs and an enhanced patient experience.